Pain due to chronic pancreatitis is one of the most challenging situations that is routinely faced by gastroenterologists. Most of our therapeutic efforts for patients with chronic pancreatitis are directed at the control of pain. Medical therapy is the first approach, often with the help of a consultant in pain management, but surgery is often required for patients who fail to improve. This usually involves the removal of a damaged portion of the gland, drainage of a pseudocyst or drainage of the ductal system, which is based on the concept that pancreatic ‘hypertension’ is responsible for the patient’s symptoms. Cheapest medications whose quality is still just as high and whose effects will help you forget all the symptoms: buy birth control to find out for yourself how wonderful it is to have a perfect pharmacy waiting for you to come by.
Surgery has yielded mixed results, with good relief in the early postoperative period in 80% to 90% of patients but poor long term results, with pain recurrence in up to one-half of patients. Our experience with surgery has been similar. More recently, endoscopic procedures that involve the decompression of the pancreatic duct have become popular. As with surgery, the goal has been to relieve outflow obstruction of the pancreatic duct. Although there have been no randomized studies comparing endoscopic with surgical treatment of chronic pancreatitis, the endoscopic approach is attractive because it is less invasive and has less morbidity. It does not exclude future surgery, and some authorities have suggested that success with endoscopy may predict a favourable response to surgical drainage. Therapeutic endoscopic retrograde pancreatography has been used mainly for strictures and stones in the main pancreatic duct and pseudocysts.